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HomeMy WebLinkAboutGW1--04616_Well Construction - GW1_20240809 • ,1 E1VT��L w RscoRD North Caroline Depoiwocnt of Eaniromoot and I -Rpe:Qom-Dim of Water Quay . . i . ' Ill... .. .. .. . . .. WkLL CoNTRAC1OR C1 ICATION a:41'I9-A all L. _ 1. INSINFECTIOOLTipe 'i..lh Anima ‘-1.TI-1 - - - -Sage . ma Pu Senrloes LW. - g. .i►1E ZOIIEs(depth): . wIidl COnlniclortbrdIvideolibbme • _ To. lg0. __:.TO Michael C,saiie - - Flprri To - From To " -Wail Grebe elbl'E'ongraay Mime From TO - From TO TAppRos 204 Tom Aye - 7. GAO N& • TWAIN, - . Gsstle.Hayne NC 28429 From DToe 1� A. `Diersele c VlielOpt46 1r - City or Tawq Slade Zip Code From _Ft -(910 }.231.8889- From - To Ft, • Area code- Plrone number 2,WELL I FOR TIM-�- - - Fro$. GROUT: Debt' 11 1 Mesioe- S1TE W611 ID s6► m g_To -3 _ - .% - From3- To a O FLJ �' _»OO r -ICS.L1=11..._ WELL« � O5WPIA] -ey-�3 Frun_iTo . - Pt. OTHER Assc L TTM P rlI(S .!. 1:- Depth Ofmnir Slot Site 11d1aat 3.WELL U.SE(Check Bu*�Reetderdid Wader Srlppdy 1 Fratrm T - - Ft b. - h. /// DATE DRILLED -Q,"1 - Fe . _ 1 _Ft__.__M. i. Tt1E COWLETED 6:00 AM* P - • • From To FL In. in. e 111ELL LOCATION: _ - • is SAND/GRAVEL PACK: - - antt t i(.,J\\ \i 1°� (1 - ooulrFYN Chao 14c,ocver DejMe size -PAWN - l0'R -5h.1loh O�Ucos From To Ft - . (SYaatilrarr�►lranbees. SuWrtsion.Li*P .Pond.Zip Oode) From To Ft< - . • TOPOGRAPHIC/LAND SETTTNOc 1 Slope I Valley 1 net I Ridge 1 Other - (m„m sePoy b 11.DRLLWG LOG • LATITUDE _ boy.be is deems. From To - Fomartion DesOipiion -. -- mmraes,second.or LONGTTiIDE _ ILA•a baud forma 5`. ,�lyr� r 1� M i '' 1- Laditoddloogitude-soowoc: I OPS -1 Topographicfop .A 1 I b CC 1 pocoOon aired must be shorn on a USES Inns mop and l .attached b this Iona idiotusing(iPS) l'al0-4 L i Mst'4 N - WELL `` �. I�yd I. flo(.no • STREET ADDRESS O( )yq -s�1<<t4.1-- 0 C • . r - � a$gcq - . arToNr Stale . kes rode-Phone number . - • 12. RBMARM: a .L DETAIL& . - _ 4 T11:r} TOTAL U , l- IL DOEi.INELL REPLACE E>O¢7 01E1.LY YESI NO1 rmMENEM CERTIFY THAT1HBWetVHSCONSITarCHEDmAo00RIVACEMTH - �1 d ITANCAC3C.VALI0 r1SIRUCT10MST/ADMI AND HATA COPY OFmil C. WATB!LEI/EL.Ebbw Tap of C a O FT. RBcomnes TOT E WM_OMER - (lase-'+-sAbove Top ofCoNO), - �j Q - d. TOP OF CASINGts 4. FT_Above Land surface* �! V- f-c2� . . •'Top of i:atine Iendrmled altar baba Iend:Ur ohm may require siGiA DF WEU CONTRACTOR DATE of towboat In Saoorroe with15A NCA(2C A116. •A' C.Sage - _ a, YE.D-(gpnr* 1(f) Noma opTESTA;C_t',+t ' PRIIEO NAME OF PERSON CONSTRUCTING LING THE NULL - lkdohit theecrigintito the Division of Wa-Quirnywithin30slays. AWE io Ent.&n Mgt., - Fi` n Allf-3 11117 iMai}Service censer—Raleigh.IIC 770E9-4117 Phone No.DPW)733:761rs eau.c.___